Combined High-dose Radiation Therapy and Systemic Chemotherapy Improves Survival in Patients With Newly Diagnosed Metastatic Nasopharyngeal Cancer

Objectives: To investigate the efficacy of high-dose radiation therapy (RT) to the primary and regional disease in combination with systemic chemotherapy and local treatment to metastatic foci in patients with newly diagnosed metastatic nasopharyngeal carcinoma (NPC). Methods: One hundred and five consecutive patients with pathologically confirmed NPC with distant metastasis at diagnosis seen between 1995 and 2002 were reviewed. All were offered cisplatin-based chemotherapy, high-dose RT (>30 Gy) to the head and neck region, and active treatment to the metastatic foci. Results: Patients' median age was 46 years, and all had a Karnofsky Performance Score of >= 70. Eighty-nine patients (85%) had metastases confined to 1 organ. Ninety-six patients (91%) received at least 1 cycle of chemotherapy and 71 (68%) received greater than 65 Gy of radiation to the head and neck region. With a median follow-up time of 22 months (range: 2 to 142 mo), 90 patients had deceased, and the median survival time of the entire group was 25 months. The 2 and 5-year estimated overall survival rates were 50% and 17%, respectively. Radiation dose of greater than 65 Gy to the primary region (P = 0.05) and number of organs with metastases (single vs. multiple) (P = 0.002) were independent predictive factors for overall survival on log-rank tests. Only moderately severe acute toxicities, such as Radiation Therapy Oncology Group grade 3 mucositis, skin desquamation, and leukocytopenia were observed. No patient experienced grade 4 acute toxicities. Conclusions: High-dose RT is indicated for local disease control in patients with metastatic NPC, and may improve survival when actively used with systemic chemotherapy and local treatment for metastatic foci. Patients with single-organ metastases have a better prognosis as compared with those with more widespread metastases.